Extracorporeal High Intensity Focused Ultrasound Ablation in the Treatment of Patients with Large Hepatocellular Carcinoma

Abstract

As a noninvasive therapy, HIFU appears to be effective, safe, and feasible in the treatment of patients with HCC. It may play an important role in the ablation of large tumors.

High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system—current state of the art and future perspectives

“…To optimize acoustic windowing, pre-HIFU surgical rib removal (approximately two weeks before liver lesions treatment) has been reported in 95 cases (21,29,34,54). Planned iatrogenic right hydrothorax with intra-pleural infusion of warm saline solution was reported in 272 cases, to enhance HIFU coupling in cases of liver dome tumor (26,35,36,38,41,45,52,55,75).…”

“…The most frequent complications were skin burns at the application sites and osteonecrosis of ribs or vertebra along the US pathway ( Tables 5,6). Post-HIFU pain was not assessed systematically and was reported in 17 studies (384 patients undergoing liver HIFU procedures) (7,12,(19)(20)(21)(22)24,26,28,29,32,39,41,45,49,54,75) and 6 studies (62 patients receiving HIFU for pancreatic malignancies) (56,59,62,70,71,75). In only a few of those trials, a semi-quantitative evaluation tool was used to report pain level, based on the analgesic requirements (mild = no analgesic; moderate = non-steroidal anti-inflammatory drugs; severe = required morphine) (7,19,20,24,39).…”

“…This enhanced effect seems to be due to the increased action of HIFU on the tissue retaining the ethiodized oil (lipiodol) used for TACE. Two main techniques are used as a protective means during liver HIFU ablations: (I) pre-HIFU surgical rib removal (approximately two weeks before) to obtain a favorable acoustic therapeutic windowing to the liver (21,29,34,54); and (II) intra-pleural infusion of warm saline solution. Although effective, those methods drastically reduce the appeal of HIFU in terms of minimal invasiveness.…”

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

“…It allowed minimal thermal damage to tissue located between the transducer and the focal point (110). Clinical results for HIFU ablation of the tumor from China produced some encouraging findings in terms of significant tumor shrinkage and prolonged survival of patients (111)(112)(113)(114).…”

Toric HIFU Transducer for Large Thermal Ablation

“…The main technical limitation to widespread clinical use of HIFU has been the long time required to treat tumors of several cubic centimeter volumes. Until now, the clinical application of HIFU for liver tumors treatment in humans was limited to studies on hepatocellular carcinoma [8]. Our group has developed an intra operative HIFU prototype to treat liver metastases.…”